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Elizabeth Yeu,1 Damien F Goldberg,2 Francis S Mah,3 Kenneth A Beckman,4,5 Jodi I Luchs,6,7 Jonathan D Solomon,8 Darrell E White,9 Preeya K Gupta101Eastern Virginia Medical School, Virginia Eye Consultants, Norfolk, VA, USA; 2Wolstan & Goldberg Eye Associates, Torrance, CA, USA; 3Scripps Clinic Torrey Pines, La Jolla, CA, USA; 4Ohio State University, Columbus, OH, USA; 5Comprehensive Eye Care of Central Ohio, Westerville, OH, USA; 6Hofstra Northwell School of Medicine, Hempstead, NY, USA; 7South Shore Eye Care, Wantagh, NY, USA; 8Bowie Vision Institute, Bowie, MD, USA; 9Skyvision Centers, Westlake, OH, USA; 10Duke University Eye Center, Durham, NC, USAPurpose: Evaluate the safety and efficacy of cryopreserved amniotic cytokine extract (ACE) in the treatment of subjects with dry eye disease (DED).Patients and methods: This was a retrospective, multicenter, chart review of adult patients with DED that instilled cryopreserved ACE drops twice-daily for 4 or 12 weeks. Patients had corneal fluorescein staining (0–20 range) and/or a lissamine green conjunctival staining score (0–18 range) of ≥3 and ≤9 in at least 1 eye and a score ≥40 (0–100 range) of eye dryness/irritation on a visual analog scale (VAS). Following completion of a treatment course, medical records were reviewed from the initiation of therapy (baseline), and at post-treatment visits (4 weeks, 8 weeks, and 12 weeks). Patient records for visual acuity, adverse events, corneal fluorescein staining, conjunctival lissamine green staining, and symptom scores of ocular dryness/irritation were reviewed for each visit, as available. Safety and tolerability were assessed through the evaluation of patient-reported adverse events recorded in the medical records.Results: A total of 54 eligible patients were identified at 7 clinical sites; 16 patients administered ACE drops for 4-weeks, and 38 patients instilled ACE drops for 12 weeks. Significant improvements in the mean changes from baseline were observed for corneal fluorescein staining, lissamine green staining, visual acuity (LogMar) and VAS ocular symptom scores at the 4-week post-treatment visit (p

An 11-week-old unvaccinated, term Amish boy initially presented with poor feeding, microcephaly, failure to thrive, and developmental delays. His physical examination was significant for both weight and head circumference being less than the third percentile, and he was noted to have micrognathia, truncal hypotonia, and head lag. He was admitted to the pediatric hospital medicine service for further diagnostic evaluation. Laboratory studies assessing for endocrinological and metabolic etiologies yielded negative results, and imaging studies (including a chest radiograph, echocardiogram, and abdominal ultrasound) were normal. However, intracranial calcifications were noted on a head ultrasound. The etiology of his constellation of symptoms was initially thought to be infectious, but the ultimate diagnosis was not made until after discharge from the pediatric hospital medicine service., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Purpose: To compare refractive outcomes of intraoperative computer-assisted registration and intraoperative aberrometry for the reduction of cylinder during toric intraocular lens (IOL) placement., Setting: Bowie Vision Institute, Bowie, Maryland, USA., Design: Prospective randomized case series., Method: The patients were divided into 2 groups that had toric IOL implantation after phacoemulsification. The intraoperative computer-assisted registration group (Group 1) had preoperative toric calculations. The aberrometry group (Group 2) was guided by a vergence formula and intraoperative pseudophakic cylindrical measurements to determine the final IOL power and intended orientation. The primary outcome measure was the mean postoperative remaining refractive astigmatism, and it was compared with the predicted amount of cylindrical correction with the IOL., Results: Fifty-two patients (104 eyes) had sequential cataract surgery. The mean amount of cylinder correction was 1.60 diopters (D) ± 0.70 (SD) (range 0.75 to 3.08 D) in Group 1 and 1.74 ± 0.79 D (range 0.72 to 3.08 D) in Group 2. The mean remaining refractive astigmatism was -0.29 ± 0.22 D in Group 1 and -0.46 ± 0.25 D in Group 2 (P = .0003). A difference vector of 0.1 @ 87 degrees (0.31 D arithmetic mean) was calculated in Group 1 and 0.0 @ 82 degrees (0.44 D arithmetic mean) in Group 2. The correction index was 1.03 in Group 1 and 0.95 in Group 2., Conclusion: Intraoperative markerless computer-assisted registration and biometric guidance summarily yielded less remaining refractive cylinder than toric IOL placement guided by intraoperative aberrometry., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

Purpose: To compare size, circularity, and centration outcomes of continuous curvilinear capsulorhexis (CCC) performed with or without assistance from the VERUS ophthalmic caliper (Mile High Ophthalmics, Denver, CO)., Methods: This was a multicenter retrospective consecutive case controlled series review., Results: Data from 40 consecutive cases using the VERUS device for CCC were compared to 40 consecutive cases with standard manual CCC. VERUS-assisted CCC size, circularity, and centration were closer to target compared to that of manual only procedures (P < .05). The average time from initiation to completion of the capsulotomy was shorter with manual (40 ± 11 seconds) compared to VERUS-assisted (71 ± 13 seconds) cases (P < .0001)., Conclusions: The VERUS ophthalmic caliper is effective at improving size, circularity, and centration of the CCC in a time-efficient manner when compared to manual procedures performed without VERUS guidance. [J Refract Surg. 2016;32(10):654-658.]., (Copyright 2016, SLACK Incorporated.)

Unlabelled: Patients with prostate cancer treated with androgen deprivation therapy (ADT) eventually develop castrate-resistant prostate cancer (CRPC). 1,25-Dihydroxyvitamin D3 (1,25D3/calcitriol) is a potential adjuvant therapy that confers antiproliferative and pro-differentiation effects in vitro, but has had mixed results in clinical trials. The impact of the tumor microenvironment on 1,25D3 therapy in patients with CRPC has not been assessed. Transforming growth factor β (TGFβ), which is associated with the development of tumorigenic "reactive stroma" in prostate cancer, induced vitamin D3 receptor (VDR) expression in the human WPMY-1 prostate stromal cell line. Similarly, TGFβ enhanced 1,25D3-induced upregulation of CYP24A1, which metabolizes 1,25D3 and thereby limits VDR activity. Ablation of Hic-5, a TGFβ-inducible nuclear receptor coregulator, inhibited basal VDR expression, 1,25D3-induced CYP24A1 expression and metabolism of 1,25D3 and TGFβ-enhanced CYP24A1 expression. A Hic-5-responsive sequence was identified upstream (392-451 bp) of the CYP24A1 transcription start site that is occupied by VDR only in the presence of Hic-5. Ectopic expression of Hic-5 sensitized LNCaP prostate tumor cells to growth-inhibitory effects of 1,25D3 independent of CYP24A1. The sensitivity of Hic-5-expressing LNCaP cells to 1,25D3-induced growth inhibition was accentuated in coculture with Hic-5-ablated WPMY-1 cells. Therefore, these findings indicate that the search for mechanisms to sensitize prostate cancer cells to the antiproliferative effects of VDR ligands needs to account for the impact of VDR activity in the tumor microenvironment., Implications: Hic-5 acts as a coregulator with distinct effects on VDR transactivation, in prostate cancer and stromal cells, and may exert diverse effects on adjuvant therapy designed to exploit VDR activity in prostate cancer., (©2014 American Association for Cancer Research.)

Background: Cutaneous metastatic melanoma usually is locoregional, and represents less than 5% of malignancies known to metastasize to the eye and orbit. When there is intraocular involvement, it most commonly occurs in the choroid, vitreous, and retina., Methods: We report a case of a 71-year-old woman with metastatic melanoma presenting as a pigmented posterior capsular opacity in a pseudophakic eye 14 months after excisional biopsy of an ulcerative cutaneous melanoma of the upper arm., Results: Histopathology confirmed the presence of melanocytic cells on the surface of the anterior lens optic and the posterior capsular surface, as well as melanophagic invasion of the trabecular meshwork. At 7 months following enucleation, there was no evidence of recurrence by either computed tomography or sequential positron emission tomography., Conclusions: To our knowledge this is the first report of posterior capsular opacification serving as the initial manifestation of cutaneous metastatic melanoma. With the incidence of cutaneous melanoma on the rise, and an increasing number of cataract procedures performed annually, clinicians should be are of the different ways cutaneous metastatic melanoma may involve the intraocular structures of the eye.

Purpose: To determine based on preoperative corneal spherical aberration, the practicality of targeting zero total ocular postoperative spherical aberration when selecting an aspheric intraocular lens (IOL)., Methods: Consecutive cataract patients were selected to receive an aspheric IOL based on corneal spherical aberration. A target of zero postoperative total spherical aberration Z(4,0) was calculated. One of three IOLs was chosen, based on the corneal spherical aberration Z(4,0) measurement at the 6-mm optical zone. The IOL was selected based on the summation of the corneal spherical aberration and the aspheric value of the prolate optic. The intention was an absolute value of zero total spherical aberration. Statistical analysis of the postoperative total ocular wavefront profile was performed to assess the accuracy of aspheric IOL selection., Results: Forty eyes of 40 patients were available for postoperative assessment. The Tecnis Z9003 (Abbott Medical Optics) was implanted in 25 eyes with a preoperative corneal spherical aberration of +0.311±0.054 μm, the AcrySof IQ (Alcon Laboratories Inc) in 13 eyes (+0.188±0.034 μm), and the SofPort-Advanced Optic with Violet Shield (Bausch & Lomb) was implanted in 2 eyes (+0.0915 μm). Total postoperative ocular spherical aberration for the entire group measured +0.019±0.051 μm (Tecnis: +0.024±0.058 μm; AcrySof IQ: +0.010±0.035 μm; and SofPort AOV: +0.037 μm). Mean absolute predictive error, for the entire group, measured +0.025±0.020 μm., Conclusions: Skiascopy-derived total wavefront measurement of spherical aberration is a reproducible method of aspheric IOL selection and permits more precise control of total ocular spherical aberration., (Copyright 2010, SLACK Incorporated.)

Background: The US Centers for Disease Control and Prevention (CDC) guidelines and the World Health Organization (WHO) both recommend HIV testing in health-care settings. However, neither organization provides prescriptive details regarding how these recommendations should be adapted into clinical practice in an emergency department., Methods: We have implemented an HIV-testing program in the ED of a major academic medical center within the scope of the Universal Screening for HIV Infection in the Emergency Room (USHER) Trial-a randomized clinical trial evaluating the feasibility and cost-effectiveness of HIV screening in this setting., Results and Conclusion: Drawing on our collective experiences in establishing programs domestically and internationally, we offer a practical framework of lessons learned so that others poised to embark on such HIV testing programs may benefit from our experiences.

Purpose: (1) To investigate the relationship between dry eye symptoms and lipid layer thickness (LLT) in patients presenting for routine eye examination and (2) to consider the practicality of interferometry in a clinical practice., Methods: Patients presenting consecutively for routine eye examinations were recruited (n = 137, age range = 18-60 years, mean = 41.7 +/- 15.5 years, 102 females and 35 males). Patients were required to complete the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire after which their LLT was evaluated using a new interferometer (Ocular Surface Interferometer). Patients were assigned to 1 of 3 symptom categories: no symptoms (SPEED = 0), mild to moderate symptoms (SPEED = 1-9), and severe symptoms (SPEED > or = 10). Categorical analysis (contingency table) and linear regression were performed on the data., Results: For patients with severe dry eye symptoms, 74% had an LLT < or =60 nm. Conversely, 72% of patients with no dry eye symptoms had an LLT of > or =75 nm (contingency table, chi = 12.63, df = 2, p = 0.0018). Furthermore, a linear regression of LLT and SPEED score reveal a significant linear relationship (as LLT increases, SPEED score decreases; p = 0.0014)., Conclusions: (1) The data indicate that approximately 3 of 4 patients reporting severe symptoms have relatively thin lipid layers of 60 nm or less, whereas approximately 3 of 4 patients without symptoms have relatively thick lipid layers of 75 nm or more. Thus, the presence of dry eye symptoms significantly increases the likelihood of a relatively thin lipid layer. LLT seems to correlate better to symptoms, especially severe symptoms, than other reported correlations with objective clinical tests for dry eye disease. (2) Interferometry has the potential to be a practical and useful addition to clinical practice.

Background: Expanded HIV screening efforts in the United States have increased the use of rapid HIV tests in emergency departments. The reported sensitivity and specificity of rapid HIV tests exceed 99%., Objective: To assess whether a reactive rapid oral HIV test result correctly identifies adults with HIV infection in the emergency department., Design: Diagnostic test performance assessment within the framework of a randomized, clinical trial., Setting: Brigham and Women's Hospital emergency department (Boston, Massachusetts) from 7 February to 1 October 2007., Patients: 849 adults with valid rapid oral HIV test results., Intervention: Rapid HIV testing with the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test (OraSure Technologies, Bethlehem, Pennsylvania). Patients with reactive rapid test results were offered enzyme-linked immunoassay, Western blot, and plasma HIV-1 RNA testing for confirmation., Measurements: Specificity and positive likelihood ratio., Results: 39 patients had reactive results (4.6% [95% CI, 3.2% to 6.0%]). On confirmation, 5 patients were HIV-infected (prevalence, 0.6% [CI, 0.1% to 1.1%]) and 26 were non-HIV-infected (8 patients declined confirmation). The estimated rapid test specificity was 96.9% (CI, 95.7% to 98.1%). Sensitivity analyses of the true HIV status of unconfirmed cases and test sensitivity resulted in a positive likelihood ratio of 8 to 32. Western blot alone as a confirmation test provided conclusive HIV status in only 50.0% (CI, 30.8% to 69.2%) of patients at first follow-up. The addition of HIV-1 RNA testing to the confirmation protocol improved this rate to 96.2% (CI, 88.8% to 100.0%)., Limitation: Test sensitivity cannot be assessed because nonreactive OraQuick test results were not confirmed., Conclusion: Although patients with a reactive oral OraQuick HIV screening test in the emergency department had an 8- to 32-fold increased odds of HIV infection compared with the pretest odds, the specificity of the test was lower than anticipated.

Purpose: To document adverse visual effects of warm compress therapy and determine potential etiologies in subjects with dry eye symptoms., Methods: Subjects (n = 24) with dry eye symptoms were recruited. Group 1 (n = 13): baseline measurements for each eye included subjective blur, visual acuity (VA), autorefraction (AR), corneal topography (CT), central corneal curvature (CCC), lipid layer thickness (LLT), and evaluation for corneal striae and edema. A warm, moist compress (44.4-45 degrees C) was applied with gentle pressure for 30 min to the closed eyelids of the randomized experimental eye; nothing was applied to the contralateral control eye. Subjective blur, VA, AR, CT, CCC, and LLT were evaluated for each eye at 5, 15, and 30 min and 5 min after application. Striae and edema were assessed for each eye at 30 and 5 min after application. Group 2 (n = 11): the above warm compress protocol was repeated to investigate the Fischer-Schweitzer polygonal reflex at the times stated., Results: At 5 and 30 min, 71% and 88% of all subjects experienced increased subjective blur and decreased VA. At 30 min: Group 1: Of 13 experimental eyes: 13 experienced subjective blur; nine exhibited a VA decrease > or =2 lines (mean = 3.4 +/- 0.7). For the control eye, two subjects reported blur and none exhibited decreased VA. The findings for AR, CT, CCC, LLT, striae and edema did not correlate with blur or with VA decline. Group 2: Of 11 experimental eyes: 10 exhibited the polygonal reflex compared with 0 controls (p < 0.001); eight exhibited subjective blur; seven exhibited VA decrease > or =2 lines (mean = 2.9 +/- 0.9). The polygonal reflex correlated positively to visual blur (r = 0.88, p = 0.04) and to VA decrease (r = 0.79, p = 0.1)., Conclusions: Warm compress application induces transient visual degradation. Although there was no correlation between visual degradation and AR, CT, CCC, LLT, or the presence of striae or corneal edema, visual degradation correlated positively with the polygonal reflex, which was observed following warm compress application.

A new efficient stereoselective synthesis for (Z,E)-3,5-tetradecadienyl acetate (Z3,E5-14∶Ac) a potent male sex attractant for the carpenterworm,Prionoxystus robiniae (Peck), was developed. The effects of the other three isomers (Z,Z; E,Z; E,E) on the field attractiveness of the Z,E isomer toward male P. robiniae were determined. The Z, Z isomer inhibited attraction, the E, E isomer synergized attraction, and theE,Z isomer had no effect on attraction. Seven monounsaturated 14-carbon acetates were evaluated for their effect on the attractiveness of Z3,E5-14∶Ac. (E)-3-Tetradecenyl acetate enhanced attraction and (Z)-9- and (E)-5-tetradecenyl acetate reduced trap captures. (Z,E)-3,5-Tetradecadien-1-ol also reduced the attractiveness of Z3,E5-14∶Ac.

This study, based in a psychiatric hospital, reviews the incidence of breast cancer in 93 patients who had received phenothiazines prior to developing breast cancer compared with a control group of 28 patients who did not receive phenothiazines. The results indicate no significant difference in the incidence of breast cancer between those patients receiving phenothiazines and those that did not. The retrospective study covered a period of 21 years. The overall incidence of breast cancer in 63,000 female patients was found to be 1.85/1,000 as compared with 2/1,000 in the general population.

Three generations of mice were exposed to an atmosphere of 80% helium and 20% oxygen. The parent generation, born and raised in air until the experiment began, was sacrificed in two groups--one after 160 d and the other after 350 d of exposure. The F1 generation, conceived in air, born and raised in an He/O2 environment, was sacrificed after 160 d. The F2 generation, conceived, born, and raised in the He/O2 atmosphere, was sacrificed also in two groups--one after 85 d and the other after 280 d. Lung tissue from these animals was prepared by conventional methods for ultrastructural study. The most obvious alteration observed was the extensive blebbing, possibly indicative of cellular edema, seen in both the capillary endothlium and the alveolar epithelium. In addition, a highly convoluted basement membrane was observed in many areas. There was debris in some of the alveoli and an increase in platelets in the capillaries.

Comparison of sputum digestion procedures utilizing acetylcysteine-sodium hydroxide (AC) and trisodium phosphate for the isolation and culture of mycobacteria indicated that the AC procedure provides faster growth, thus permitting the earlier detection of positives. Also, in untreated patients and those in whom treatment has been recently instituted, the number of positives was slightly larger with the use of the AC procedure. However, of greater interest was finding that the AC procedure provided a larger quantity of positive cultures with sputum from subjects who had been intensively treated with antimicrobials and other drugs. Contamination was higher with the AC procedure, but when the sputa were diluted 1:10 this interference due to contamination was decreased.